NR 568 FINAL EXAM 2026/2027 |
ADVANCED PHARMACOLOGY
AGPCNP| WEEKS 5-8 QUESTIONS
AND RATIONALES
Core Domains
1. Cardiovascular Pharmacology and Anticoagulation Management
2. Endocrine Pharmacology: Diabetes and Thyroid Disorders
3. Antimicrobial and Antifungal Therapy
4. Neurologic Pharmacology: Parkinson's, Alzheimer's, and Migraine
5. Psychiatric Pharmacology: Antidepressants, Antipsychotics, and Mood
Stabilizers
6. Geriatric Pharmacokinetics and Polypharmacy Management
7. Antiretroviral and Anthelmintic Pharmacotherapy
8. Pain Management and Opioid Safety
9. Respiratory and Gastrointestinal Pharmacology
10. Monitoring, Drug Interactions, and Safety in Advanced Practice
Introduction
This comprehensive examination is designed to rigorously evaluate the
advanced practice nursing student's knowledge, clinical reasoning, and
application of pharmacologic principles in the adult-gerontology primary care
setting. The test covers essential domains including cardiovascular, endocrine,
neurologic, psychiatric, and infectious disease pharmacology, with a focus on
evidence-based prescribing, drug interactions, adverse effect monitoring, and
patient safety. Through a combination of multiple-choice questions and clinical
scenario-based items, this assessment challenges candidates to integrate
pharmacologic knowledge with clinical decision-making across diverse patient
populations. Candidates must demonstrate proficiency in medication selection,
dosing, monitoring, and management of complex pharmacotherapy in adult and
geriatric patients.
SECTION ONE: QUESTIONS 1-100
,Question 1
A 68-year-old patient with hypertension and diabetes is prescribed an ACE
inhibitor. Which adverse effect should the AGPCNP monitor for?
A. Hypokalemia
B. Dry cough
C. Bradycardia
D. Constipation
B. Dry cough
RATIONALE: ACE inhibitors increase bradykinin levels, which commonly
causes a persistent dry cough. Hyperkalemia, not hypokalemia, is also a potential
adverse effect. Bradycardia and constipation are not typical side effects of ACE
inhibitors .
Question 2
Which medication class is considered first-line therapy for uncomplicated
hypertension in older adults?
A. Benzodiazepines
B. Thiazide diuretics
C. Opioids
D. Proton pump inhibitors
B. Thiazide diuretics
RATIONALE: Thiazide diuretics are effective first-line antihypertensive
agents, especially in older adults, due to their cardiovascular risk reduction and
proven benefit in reducing stroke and heart failure events .
Question 3
A patient taking warfarin has an INR of 5.5. What is the priority action?
A. Increase the warfarin dose
B. Continue therapy without changes
C. Hold medication and evaluate bleeding risk
D. Administer aspirin
, C. Hold medication and evaluate bleeding risk
RATIONALE: A supratherapeutic INR (above 4.0) increases bleeding risk
significantly. The medication should be held and further management determined
based on bleeding status. Vitamin K may be indicated if there is evidence of
bleeding .
Question 4
Which anticoagulant does NOT require routine INR monitoring?
A. Warfarin
B. Apixaban
C. Heparin
D. Enoxaparin
B. Apixaban
RATIONALE: Direct oral anticoagulants (DOACs) like apixaban do not
require routine INR monitoring. Warfarin requires INR monitoring; heparin is
monitored by aPTT; and enoxaparin may be monitored with anti-Xa levels in
certain situations .
Question 5
A 65-year-old male with heart failure with reduced ejection fraction (HFrEF) (EF
35%) is on carvedilol 25 mg twice daily, lisinopril 20 mg daily, and furosemide 40
mg daily. He continues to have dyspnea on exertion and peripheral edema. Which
of the following is the most appropriate add-on therapy to reduce mortality?
A. Spironolactone 25 mg daily
B. Digoxin 0.125 mg daily
C. Hydralazine/isosorbide dinitrate (BiDil)
D. Amlodipine 5 mg daily
A. Spironolactone 25 mg daily
RATIONALE: Guideline-directed medical therapy (GDMT) for HFrEF
includes an ACE inhibitor/ARB/ARNI, a beta-blocker (carvedilol, metoprolol
succinate, bisoprolol), an aldosterone antagonist (spironolactone, eplerenone), and
an SGLT2 inhibitor (dapagliflozin, empagliflozin). This patient is already on an
, ACE inhibitor and a beta-blocker. The next step to reduce mortality and
hospitalizations is to add spironolactone (aldosterone antagonist). Spironolactone
reduces mortality by approximately 30% in patients with NYHA class II-IV
HFrEF .
Question 7
A patient taking metformin should be monitored for which serious adverse effect?
A. Lactic acidosis
B. Pulmonary embolism
C. Severe hypertension
D. Hyperthyroidism
A. Lactic acidosis
RATIONALE: Metformin-associated lactic acidosis is rare but serious,
especially with renal impairment. Risk factors include acute kidney injury, liver
disease, and sepsis. The medication should be held in patients with unstable
conditions that may lead to acute renal failure .
Question 8
Which medication is most associated with hypoglycemia?
A. Insulin
B. Metformin
C. Acarbose
D. Empagliflozin
A. Insulin
RATIONALE: Insulin directly lowers blood glucose and can cause
hypoglycemia if dosing exceeds patient needs. Sulfonylureas also carry significant
hypoglycemia risk. Metformin, acarbose, and SGLT2 inhibitors have lower
hypoglycemia risk when used as monotherapy .
Question 9
A patient prescribed a GLP-1 receptor agonist should be educated about which
common adverse effect?
ADVANCED PHARMACOLOGY
AGPCNP| WEEKS 5-8 QUESTIONS
AND RATIONALES
Core Domains
1. Cardiovascular Pharmacology and Anticoagulation Management
2. Endocrine Pharmacology: Diabetes and Thyroid Disorders
3. Antimicrobial and Antifungal Therapy
4. Neurologic Pharmacology: Parkinson's, Alzheimer's, and Migraine
5. Psychiatric Pharmacology: Antidepressants, Antipsychotics, and Mood
Stabilizers
6. Geriatric Pharmacokinetics and Polypharmacy Management
7. Antiretroviral and Anthelmintic Pharmacotherapy
8. Pain Management and Opioid Safety
9. Respiratory and Gastrointestinal Pharmacology
10. Monitoring, Drug Interactions, and Safety in Advanced Practice
Introduction
This comprehensive examination is designed to rigorously evaluate the
advanced practice nursing student's knowledge, clinical reasoning, and
application of pharmacologic principles in the adult-gerontology primary care
setting. The test covers essential domains including cardiovascular, endocrine,
neurologic, psychiatric, and infectious disease pharmacology, with a focus on
evidence-based prescribing, drug interactions, adverse effect monitoring, and
patient safety. Through a combination of multiple-choice questions and clinical
scenario-based items, this assessment challenges candidates to integrate
pharmacologic knowledge with clinical decision-making across diverse patient
populations. Candidates must demonstrate proficiency in medication selection,
dosing, monitoring, and management of complex pharmacotherapy in adult and
geriatric patients.
SECTION ONE: QUESTIONS 1-100
,Question 1
A 68-year-old patient with hypertension and diabetes is prescribed an ACE
inhibitor. Which adverse effect should the AGPCNP monitor for?
A. Hypokalemia
B. Dry cough
C. Bradycardia
D. Constipation
B. Dry cough
RATIONALE: ACE inhibitors increase bradykinin levels, which commonly
causes a persistent dry cough. Hyperkalemia, not hypokalemia, is also a potential
adverse effect. Bradycardia and constipation are not typical side effects of ACE
inhibitors .
Question 2
Which medication class is considered first-line therapy for uncomplicated
hypertension in older adults?
A. Benzodiazepines
B. Thiazide diuretics
C. Opioids
D. Proton pump inhibitors
B. Thiazide diuretics
RATIONALE: Thiazide diuretics are effective first-line antihypertensive
agents, especially in older adults, due to their cardiovascular risk reduction and
proven benefit in reducing stroke and heart failure events .
Question 3
A patient taking warfarin has an INR of 5.5. What is the priority action?
A. Increase the warfarin dose
B. Continue therapy without changes
C. Hold medication and evaluate bleeding risk
D. Administer aspirin
, C. Hold medication and evaluate bleeding risk
RATIONALE: A supratherapeutic INR (above 4.0) increases bleeding risk
significantly. The medication should be held and further management determined
based on bleeding status. Vitamin K may be indicated if there is evidence of
bleeding .
Question 4
Which anticoagulant does NOT require routine INR monitoring?
A. Warfarin
B. Apixaban
C. Heparin
D. Enoxaparin
B. Apixaban
RATIONALE: Direct oral anticoagulants (DOACs) like apixaban do not
require routine INR monitoring. Warfarin requires INR monitoring; heparin is
monitored by aPTT; and enoxaparin may be monitored with anti-Xa levels in
certain situations .
Question 5
A 65-year-old male with heart failure with reduced ejection fraction (HFrEF) (EF
35%) is on carvedilol 25 mg twice daily, lisinopril 20 mg daily, and furosemide 40
mg daily. He continues to have dyspnea on exertion and peripheral edema. Which
of the following is the most appropriate add-on therapy to reduce mortality?
A. Spironolactone 25 mg daily
B. Digoxin 0.125 mg daily
C. Hydralazine/isosorbide dinitrate (BiDil)
D. Amlodipine 5 mg daily
A. Spironolactone 25 mg daily
RATIONALE: Guideline-directed medical therapy (GDMT) for HFrEF
includes an ACE inhibitor/ARB/ARNI, a beta-blocker (carvedilol, metoprolol
succinate, bisoprolol), an aldosterone antagonist (spironolactone, eplerenone), and
an SGLT2 inhibitor (dapagliflozin, empagliflozin). This patient is already on an
, ACE inhibitor and a beta-blocker. The next step to reduce mortality and
hospitalizations is to add spironolactone (aldosterone antagonist). Spironolactone
reduces mortality by approximately 30% in patients with NYHA class II-IV
HFrEF .
Question 7
A patient taking metformin should be monitored for which serious adverse effect?
A. Lactic acidosis
B. Pulmonary embolism
C. Severe hypertension
D. Hyperthyroidism
A. Lactic acidosis
RATIONALE: Metformin-associated lactic acidosis is rare but serious,
especially with renal impairment. Risk factors include acute kidney injury, liver
disease, and sepsis. The medication should be held in patients with unstable
conditions that may lead to acute renal failure .
Question 8
Which medication is most associated with hypoglycemia?
A. Insulin
B. Metformin
C. Acarbose
D. Empagliflozin
A. Insulin
RATIONALE: Insulin directly lowers blood glucose and can cause
hypoglycemia if dosing exceeds patient needs. Sulfonylureas also carry significant
hypoglycemia risk. Metformin, acarbose, and SGLT2 inhibitors have lower
hypoglycemia risk when used as monotherapy .
Question 9
A patient prescribed a GLP-1 receptor agonist should be educated about which
common adverse effect?
