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NR 565 MIDTERM EXAM – ADVANCED PHARMACOLOGY
FUNDAMENTALS CHAMBERLAIN 2026/2027 COMPLETE
(100) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PHARMACOLOGY
Prepare for the Chamberlain NR 565 Midterm Exam – Advanced Pharmacology
Fundamentals with a focused study resource covering essential pharmacology
concepts relevant to advanced nursing practice. It supports review of medication
principles, pharmacokinetics, pharmacodynamics, drug classifications, therapeutic
considerations, and safe medication management. Use the material to reinforce your
understanding, improve recall, and identify areas that may require additional study
before the midterm. This resource is best suited for Chamberlain University NR 565
students preparing for the midterm and reviewing advanced pharmacology
fundamentals.
MULTIPLE CHOICE.
1. A patient with hypertension is prescribed a thiazide diuretic. Which of
the following best describes the mechanism of action of this drug class?
• A) Inhibition of the Na⁺/K⁺/2Cl⁻ cotransporter in the thick ascending
limb
• B) Inhibition of the Na⁺/Cl⁻ cotransporter in the distal convoluted tubule
• C) Antagonism of aldosterone receptors in the collecting duct
• D) Osmotic retention of water in the proximal tubule
Answer: B
Rationale: Thiazide diuretics inhibit the Na⁺/Cl⁻ cotransporter in the distal
convoluted tubule. Option A describes loop diuretics, Option C describes
potassium-sparing diuretics (spironolactone), and Option D describes
osmotic diuretics (mannitol).
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2. A patient is prescribed warfarin. Which of the following laboratory
values is most critical to monitor for therapeutic efficacy and safety?
• A) Activated partial thromboplastin time (aPTT)
• B) Prothrombin time (PT) and International Normalized Ratio (INR)
• C) Platelet count
• D) Fibrinogen level
Answer: B
Rationale: Warfarin’s effect is monitored via PT/INR, which measures the
extrinsic pathway (factors II, VII, IX, X). aPTT monitors heparin therapy,
platelet count monitors for HIT, and fibrinogen is not specific for warfarin
monitoring.
3. A patient with Type 2 diabetes and renal impairment is started on
metformin. What is the most important safety concern the NP must
monitor?
• A) Hypoglycemia
• B) Lactic acidosis
• C) Weight gain
• D) Hepatotoxicity
Answer: B
Rationale: Metformin carries a black-box warning for lactic acidosis,
particularly in patients with renal impairment (eGFR < 30 mL/min) due to
drug accumulation. Hypoglycemia is rare with metformin monotherapy,
weight gain is not typical, and hepatotoxicity is uncommon.
4. A 62-year-old male is prescribed lisinopril for heart failure with reduced
ejection fraction. Which adverse effect is most characteristic of this ACE
inhibitor?
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• A) Dry cough
• B) Peripheral edema
• C) Hyperkalemia
• D) Both A and C
Answer: D
Rationale: ACE inhibitors commonly cause a dry cough (due to bradykinin
accumulation) and hyperkalemia (due to reduced aldosterone). Peripheral
edema is more common with calcium channel blockers. Both A and C are
correct.
5. A patient is newly started on levothyroxine for hypothyroidism. What is
the most appropriate patient education regarding administration?
• A) Take with food to decrease GI upset
• B) Take on an empty stomach 30-60 minutes before breakfast
• C) Take at bedtime with a snack
• D) Take with calcium supplements for better absorption
Answer: B
Rationale: Levothyroxine should be taken on an empty stomach, 30-60
minutes before breakfast, to maximize absorption. Food, calcium, iron,
and antacids significantly reduce absorption.
6. A 75-year-old patient with chronic insomnia asks about over-the-
counter diphenhydramine. Which of the following is a major concern for
this patient?
• A) Anticholinergic effects including cognitive decline and falls
• B) Weight gain
• C) Hepatotoxicity
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• D) Nephrotoxicity
Answer: A
Rationale: Older adults are highly sensitive to the anticholinergic effects
of diphenhydramine, including confusion, sedation, and orthostatic
hypotension, increasing fall risk and cognitive decline. It is on the Beers
Criteria for potentially inappropriate medications in older adults.
7. A patient on sertraline for major depressive disorder reports new-onset
bruising and GI bleeding. This adverse effect is most likely due to which
mechanism?
• A) Inhibition of CYP450 enzymes
• B) Platelet serotonin uptake inhibition impairing aggregation
• C) Induction of gastric acid secretion
• D) Direct gastric mucosal erosion
Answer: B
Rationale: SSRIs like sertraline inhibit serotonin uptake in platelets,
which impairs platelet aggregation and increases bleeding risk. This is not
a CYP450 interaction, acid-related, or direct mucosal damage.
8. According to the Beers Criteria, which class of medications should be
avoided in older adults for the treatment of insomnia?
• A) Melatonin receptor agonists
• B) Non-benzodiazepine hypnotics (zolpidem)
• C) Benzodiazepines
• D) Doxepin (low dose)
Answer: C
Rationale: Benzodiazepines are on the Beers Criteria for avoidance in
older adults due to increased risk of cognitive impairment, delirium, falls,
NR 565 MIDTERM EXAM – ADVANCED PHARMACOLOGY
FUNDAMENTALS CHAMBERLAIN 2026/2027 COMPLETE
(100) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PHARMACOLOGY
Prepare for the Chamberlain NR 565 Midterm Exam – Advanced Pharmacology
Fundamentals with a focused study resource covering essential pharmacology
concepts relevant to advanced nursing practice. It supports review of medication
principles, pharmacokinetics, pharmacodynamics, drug classifications, therapeutic
considerations, and safe medication management. Use the material to reinforce your
understanding, improve recall, and identify areas that may require additional study
before the midterm. This resource is best suited for Chamberlain University NR 565
students preparing for the midterm and reviewing advanced pharmacology
fundamentals.
MULTIPLE CHOICE.
1. A patient with hypertension is prescribed a thiazide diuretic. Which of
the following best describes the mechanism of action of this drug class?
• A) Inhibition of the Na⁺/K⁺/2Cl⁻ cotransporter in the thick ascending
limb
• B) Inhibition of the Na⁺/Cl⁻ cotransporter in the distal convoluted tubule
• C) Antagonism of aldosterone receptors in the collecting duct
• D) Osmotic retention of water in the proximal tubule
Answer: B
Rationale: Thiazide diuretics inhibit the Na⁺/Cl⁻ cotransporter in the distal
convoluted tubule. Option A describes loop diuretics, Option C describes
potassium-sparing diuretics (spironolactone), and Option D describes
osmotic diuretics (mannitol).
, Page 2 of 43
2. A patient is prescribed warfarin. Which of the following laboratory
values is most critical to monitor for therapeutic efficacy and safety?
• A) Activated partial thromboplastin time (aPTT)
• B) Prothrombin time (PT) and International Normalized Ratio (INR)
• C) Platelet count
• D) Fibrinogen level
Answer: B
Rationale: Warfarin’s effect is monitored via PT/INR, which measures the
extrinsic pathway (factors II, VII, IX, X). aPTT monitors heparin therapy,
platelet count monitors for HIT, and fibrinogen is not specific for warfarin
monitoring.
3. A patient with Type 2 diabetes and renal impairment is started on
metformin. What is the most important safety concern the NP must
monitor?
• A) Hypoglycemia
• B) Lactic acidosis
• C) Weight gain
• D) Hepatotoxicity
Answer: B
Rationale: Metformin carries a black-box warning for lactic acidosis,
particularly in patients with renal impairment (eGFR < 30 mL/min) due to
drug accumulation. Hypoglycemia is rare with metformin monotherapy,
weight gain is not typical, and hepatotoxicity is uncommon.
4. A 62-year-old male is prescribed lisinopril for heart failure with reduced
ejection fraction. Which adverse effect is most characteristic of this ACE
inhibitor?
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• A) Dry cough
• B) Peripheral edema
• C) Hyperkalemia
• D) Both A and C
Answer: D
Rationale: ACE inhibitors commonly cause a dry cough (due to bradykinin
accumulation) and hyperkalemia (due to reduced aldosterone). Peripheral
edema is more common with calcium channel blockers. Both A and C are
correct.
5. A patient is newly started on levothyroxine for hypothyroidism. What is
the most appropriate patient education regarding administration?
• A) Take with food to decrease GI upset
• B) Take on an empty stomach 30-60 minutes before breakfast
• C) Take at bedtime with a snack
• D) Take with calcium supplements for better absorption
Answer: B
Rationale: Levothyroxine should be taken on an empty stomach, 30-60
minutes before breakfast, to maximize absorption. Food, calcium, iron,
and antacids significantly reduce absorption.
6. A 75-year-old patient with chronic insomnia asks about over-the-
counter diphenhydramine. Which of the following is a major concern for
this patient?
• A) Anticholinergic effects including cognitive decline and falls
• B) Weight gain
• C) Hepatotoxicity
, Page 4 of 43
• D) Nephrotoxicity
Answer: A
Rationale: Older adults are highly sensitive to the anticholinergic effects
of diphenhydramine, including confusion, sedation, and orthostatic
hypotension, increasing fall risk and cognitive decline. It is on the Beers
Criteria for potentially inappropriate medications in older adults.
7. A patient on sertraline for major depressive disorder reports new-onset
bruising and GI bleeding. This adverse effect is most likely due to which
mechanism?
• A) Inhibition of CYP450 enzymes
• B) Platelet serotonin uptake inhibition impairing aggregation
• C) Induction of gastric acid secretion
• D) Direct gastric mucosal erosion
Answer: B
Rationale: SSRIs like sertraline inhibit serotonin uptake in platelets,
which impairs platelet aggregation and increases bleeding risk. This is not
a CYP450 interaction, acid-related, or direct mucosal damage.
8. According to the Beers Criteria, which class of medications should be
avoided in older adults for the treatment of insomnia?
• A) Melatonin receptor agonists
• B) Non-benzodiazepine hypnotics (zolpidem)
• C) Benzodiazepines
• D) Doxepin (low dose)
Answer: C
Rationale: Benzodiazepines are on the Beers Criteria for avoidance in
older adults due to increased risk of cognitive impairment, delirium, falls,
