, 2025 PHARMACOTHERAPEUTICS PRACTICE
EXAM BOOK: ARCANGELO & PETERSON 5TH
EDITION
📘 Verified | Detailed Rationales | 1,120 Questions | Designed for Guaranteed Clinical
Competency
Table of Contents
1. Issues for the Practitioner in Drug Therapy
2. Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles
3. Impact of Drug Interactions and Adverse Events on Therapeutics
4. Principles of Pharmacotherapy in Pediatrics, Pregnancy and Lactation
5. Pharmacotherapy Principles in Older Adults
6. Principles of Antimicrobial Therapy
7. Pharmacogenomics
8. The Economics of Pharmacotherapeutics
9. Principles of Pharmacology in Pain Management
10. Pain Management in Opioid Use Disorder (OUD) Patients
11. Cannabis and Pain Management
12. Dermatitis
13. Bacterial, Fungal, and Viral Infections of the Skin
14. Psoriasis
15. Acne Vulgaris and Rosacea
16. Ophthalmic Disorders
17. Otitis Media and Otitis Externa
18. Hypertension
19. Hyperlipidemia
20. Chronic Stable Angina and Myocardial Infarction
,21. Heart Failure
22. Arrhythmias
23. Respiratory Infections
24. Asthma and Chronic Obstructive Pulmonary Disease
25. Gastric, Functional and Inflammatory Bowel Disorders
26. Gastroesophageal Reflux Disease and Peptic Ulcer Disease
27. Liver Diseases
28. Urinary Tract Infection
29. Prostatic Disorders and Erectile Dysfunction
30. Overactive Bladder
31. Sexually Transmitted Infections
32. Osteoarthritis and Gout
33. Osteoporosis
34. Rheumatoid Arthritis
35. Headaches
36. Seizure Disorders
37. Alzheimer’s Disease
38. Parkinson Disease
39. Major Depressive Disorder and Bipolar Disorders
40. Anxiety Disorders
41. Sleep Disorders
42. Attention Deficit Hyperactivity Disorder
43. Substance Use Disorders
44. Diabetes Mellitus
45. Thyroid and Parathyroid Disorders
46. Allergies and Allergic Reactions
47. Human Immunodeficiency Virus
,48. Organ Transplantation
49. Pharmacotherapy for Select Thromboembolic Disorders
50. Anemias
51. Immunizations
52. Smoking Cessation
53. Weight Loss
54. Contraception
55. Menopause
56. Vaginitis
,1. An APP in State A is uncertain about prescribing a
schedule II controlled substance. Which resource is most
appropriate to verify the legal scope before writing the
prescription? A. The APP’s collaborating physician’s
personal notes
B. The state’s Board of Nursing or Pharmacy regulations
C. A nationally published pharmacology textbook
D. The patient’s previous medical record
Answer: B
Rationale: State Boards regulate scope and controlled
substances; national textbooks do not detail state laws (C),
collaborating physician’s notes may be outdated (A), and
patient records don’t clarify legal scope (D).
2. An APP reviews a patient’s medication list and notes
multiple antihypertensives from different classes. Which
principle guides avoidance of polypharmacy? A.
Therapeutic duplication should be maximized
B. Use of lowest effective dose and monotherapy when
possible
C. Adding medications until blood pressure is drastically
lowered
D. Prescribe brand names only
Answer: B
Rationale: Polypharmacy avoidance emphasizes
monotherapy at lowest dose; duplication (A) and
aggressive lowering (C) increase risk; brand vs generic (D)
is unrelated.
,3. A patient’s lab results indicate declining renal function.
Which action exemplifies evidence-based prescribing? A.
Continue current dose until symptoms worsen
B. Adjust dosage based on creatinine clearance guidelines
C. Switch to a more expensive brand-name drug
D. Discontinue all medications immediately
Answer: B
Rationale: Adjusting dose per renal function follows
guidelines; waiting for symptoms (A) is reactive, brand-
name switch (C) not evidence-based, stopping all meds (D)
may harm.
4. Which strategy best promotes medication adherence in a
patient with low health literacy? A. Provide complex
written instructions
B. Use teach-back method with simple language
C. Assume understanding after verbal counsel
D. Send automated reminder emails only
Answer: B
Rationale: Teach-back ensures comprehension; complex
materials (A) hinder literacy, assumption (C) risks
misunderstanding, emails (D) may be inaccessible.
5. Under the ethical principle of nonmaleficence, an APP
should: A. Prescribe high-risk medication without
monitoring
B. Avoid treatments with unacceptable risk–benefit ratio
C. Prioritize provider convenience over patient safety
, D. Ignore patient preferences if evidence is lacking
Answer: B
Rationale: Nonmaleficence means do no harm; high-risk
prescribing (A) and ignoring safety (C) breach principle;
dismissing preferences (D) violates autonomy.
6. A patient requests an off-label medication. Which is the
best APP response? A. Refuse to consider off-label use
B. Discuss evidence, risks, and gain informed consent
C. Prescribe without explanation if APP believes it works
D. Refer immediately to another provider
Answer: B
Rationale: Informed off-label prescribing includes risk
discussion and consent; refusal (A) and unilateral
prescribing (C) are unethical; referral (D) unnecessary if
within scope.
7. Which action demonstrates cultural competence when
prescribing to a patient from a non-Western background?
A. Insist on Western beliefs about medication
B. Elicit patient beliefs and integrate cultural preferences
C. Avoid discussing cultural practices to focus on meds
D. Automatically reduce dosage due to cultural difference
Answer: B
Rationale: Integrating beliefs fosters adherence; imposing
beliefs (A), ignoring culture (C), and arbitrary dose changes
(D) are inappropriate.
,8. An APP identifies potential drug–drug interaction in a
polypharmacy patient. Which is the next best step? A.
Discontinue all medications
B. Review interaction severity and adjust regimen
C. Document and proceed unchanged
D. Add another agent to counteract interaction
Answer: B
Rationale: Assessing severity and adjusting follows safe
practice; stopping all meds (A) or ignoring (C) risks harm;
adding counteragent (D) complicates regimen.
9. State B requires collaborative practice agreements (CPAs)
for APP prescribing. Which element is essential in a CPA?
A. Patient’s insurance details
B. Scope of prescriptive authority
C. APP’s personal preferences
D. CPA duration in weeks only
Answer: B
Rationale: CPAs must define prescriptive scope; insurance
(A) and preferences (C) irrelevant; duration can vary, not
limited to weeks (D).
10. A patient expresses concern about medication cost.
Which provider accountability action aligns with ethical
prescribing? A. Prescribe only newest, expensive therapy
B. Explore generic alternatives and patient assistance
C. Dismiss cost concern as nonclinical
D. Advise patient to skip doses when low on funds
, Answer: B
Rationale: Considering affordability demonstrates
accountability; prescribing expensive only (A), dismissing
(C), or advising dose skipping (D) are unethical.
11. Which approach ensures shared decision-making in
initiating statin therapy? A. Prescribe without discussing
alternatives
B. Review risks, benefits, and patient values collaboratively
C. Insist on therapy based solely on guidelines
D. Delegate decision entirely to patient
Answer: B
Rationale: Shared decision-making balances evidence with
patient values; unilateral prescribing (A/C) and full
delegation (D) neglect clinical guidance or support.
12. An elderly patient is on five chronic medications.
What screening tool helps assess risk of inappropriate
polypharmacy? A. Glasgow Coma Scale
B. Beers Criteria
C. APGAR score
D. Braden Scale
Answer: B
Rationale: Beers Criteria identifies potentially
inappropriate meds in elderly; other tools assess unrelated
parameters.
13. An APP documents rationale for prescribing
antibiotic prophylaxis. Which best demonstrates
, accountability? A. "Patient requested antibiotic"
B. "Based on evidence for surgical-site infection
prevention"
C. "To cover all possible infections"
D. "Standard practice without review"
Answer: B
Rationale: Evidence-based rationale shows accountability;
patient request (A), blanket coverage (C), and unsupported
standard (D) lack justification.
14. When is it appropriate for an APP to co-sign a
prescription under a DEA mid-level registration? A.
Always, regardless of state law
B. Only when required by state controlled-substance
regulations
C. Never; co-signatures are obsolete
D. Only for Schedule V drugs
Answer: B
Rationale: Co-signature requirements depend on state
regulations; blanket statements (A/C/D) are incorrect.
15. Which tactic can improve adherence in a patient
with complex dosing schedule? A. Simplify to once-daily
extended-release formulations
B. Increase pill burden to reinforce regimen
C. Avoid pillboxes or reminders
D. Provide verbal instructions only once
Answer: A
EXAM BOOK: ARCANGELO & PETERSON 5TH
EDITION
📘 Verified | Detailed Rationales | 1,120 Questions | Designed for Guaranteed Clinical
Competency
Table of Contents
1. Issues for the Practitioner in Drug Therapy
2. Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles
3. Impact of Drug Interactions and Adverse Events on Therapeutics
4. Principles of Pharmacotherapy in Pediatrics, Pregnancy and Lactation
5. Pharmacotherapy Principles in Older Adults
6. Principles of Antimicrobial Therapy
7. Pharmacogenomics
8. The Economics of Pharmacotherapeutics
9. Principles of Pharmacology in Pain Management
10. Pain Management in Opioid Use Disorder (OUD) Patients
11. Cannabis and Pain Management
12. Dermatitis
13. Bacterial, Fungal, and Viral Infections of the Skin
14. Psoriasis
15. Acne Vulgaris and Rosacea
16. Ophthalmic Disorders
17. Otitis Media and Otitis Externa
18. Hypertension
19. Hyperlipidemia
20. Chronic Stable Angina and Myocardial Infarction
,21. Heart Failure
22. Arrhythmias
23. Respiratory Infections
24. Asthma and Chronic Obstructive Pulmonary Disease
25. Gastric, Functional and Inflammatory Bowel Disorders
26. Gastroesophageal Reflux Disease and Peptic Ulcer Disease
27. Liver Diseases
28. Urinary Tract Infection
29. Prostatic Disorders and Erectile Dysfunction
30. Overactive Bladder
31. Sexually Transmitted Infections
32. Osteoarthritis and Gout
33. Osteoporosis
34. Rheumatoid Arthritis
35. Headaches
36. Seizure Disorders
37. Alzheimer’s Disease
38. Parkinson Disease
39. Major Depressive Disorder and Bipolar Disorders
40. Anxiety Disorders
41. Sleep Disorders
42. Attention Deficit Hyperactivity Disorder
43. Substance Use Disorders
44. Diabetes Mellitus
45. Thyroid and Parathyroid Disorders
46. Allergies and Allergic Reactions
47. Human Immunodeficiency Virus
,48. Organ Transplantation
49. Pharmacotherapy for Select Thromboembolic Disorders
50. Anemias
51. Immunizations
52. Smoking Cessation
53. Weight Loss
54. Contraception
55. Menopause
56. Vaginitis
,1. An APP in State A is uncertain about prescribing a
schedule II controlled substance. Which resource is most
appropriate to verify the legal scope before writing the
prescription? A. The APP’s collaborating physician’s
personal notes
B. The state’s Board of Nursing or Pharmacy regulations
C. A nationally published pharmacology textbook
D. The patient’s previous medical record
Answer: B
Rationale: State Boards regulate scope and controlled
substances; national textbooks do not detail state laws (C),
collaborating physician’s notes may be outdated (A), and
patient records don’t clarify legal scope (D).
2. An APP reviews a patient’s medication list and notes
multiple antihypertensives from different classes. Which
principle guides avoidance of polypharmacy? A.
Therapeutic duplication should be maximized
B. Use of lowest effective dose and monotherapy when
possible
C. Adding medications until blood pressure is drastically
lowered
D. Prescribe brand names only
Answer: B
Rationale: Polypharmacy avoidance emphasizes
monotherapy at lowest dose; duplication (A) and
aggressive lowering (C) increase risk; brand vs generic (D)
is unrelated.
,3. A patient’s lab results indicate declining renal function.
Which action exemplifies evidence-based prescribing? A.
Continue current dose until symptoms worsen
B. Adjust dosage based on creatinine clearance guidelines
C. Switch to a more expensive brand-name drug
D. Discontinue all medications immediately
Answer: B
Rationale: Adjusting dose per renal function follows
guidelines; waiting for symptoms (A) is reactive, brand-
name switch (C) not evidence-based, stopping all meds (D)
may harm.
4. Which strategy best promotes medication adherence in a
patient with low health literacy? A. Provide complex
written instructions
B. Use teach-back method with simple language
C. Assume understanding after verbal counsel
D. Send automated reminder emails only
Answer: B
Rationale: Teach-back ensures comprehension; complex
materials (A) hinder literacy, assumption (C) risks
misunderstanding, emails (D) may be inaccessible.
5. Under the ethical principle of nonmaleficence, an APP
should: A. Prescribe high-risk medication without
monitoring
B. Avoid treatments with unacceptable risk–benefit ratio
C. Prioritize provider convenience over patient safety
, D. Ignore patient preferences if evidence is lacking
Answer: B
Rationale: Nonmaleficence means do no harm; high-risk
prescribing (A) and ignoring safety (C) breach principle;
dismissing preferences (D) violates autonomy.
6. A patient requests an off-label medication. Which is the
best APP response? A. Refuse to consider off-label use
B. Discuss evidence, risks, and gain informed consent
C. Prescribe without explanation if APP believes it works
D. Refer immediately to another provider
Answer: B
Rationale: Informed off-label prescribing includes risk
discussion and consent; refusal (A) and unilateral
prescribing (C) are unethical; referral (D) unnecessary if
within scope.
7. Which action demonstrates cultural competence when
prescribing to a patient from a non-Western background?
A. Insist on Western beliefs about medication
B. Elicit patient beliefs and integrate cultural preferences
C. Avoid discussing cultural practices to focus on meds
D. Automatically reduce dosage due to cultural difference
Answer: B
Rationale: Integrating beliefs fosters adherence; imposing
beliefs (A), ignoring culture (C), and arbitrary dose changes
(D) are inappropriate.
,8. An APP identifies potential drug–drug interaction in a
polypharmacy patient. Which is the next best step? A.
Discontinue all medications
B. Review interaction severity and adjust regimen
C. Document and proceed unchanged
D. Add another agent to counteract interaction
Answer: B
Rationale: Assessing severity and adjusting follows safe
practice; stopping all meds (A) or ignoring (C) risks harm;
adding counteragent (D) complicates regimen.
9. State B requires collaborative practice agreements (CPAs)
for APP prescribing. Which element is essential in a CPA?
A. Patient’s insurance details
B. Scope of prescriptive authority
C. APP’s personal preferences
D. CPA duration in weeks only
Answer: B
Rationale: CPAs must define prescriptive scope; insurance
(A) and preferences (C) irrelevant; duration can vary, not
limited to weeks (D).
10. A patient expresses concern about medication cost.
Which provider accountability action aligns with ethical
prescribing? A. Prescribe only newest, expensive therapy
B. Explore generic alternatives and patient assistance
C. Dismiss cost concern as nonclinical
D. Advise patient to skip doses when low on funds
, Answer: B
Rationale: Considering affordability demonstrates
accountability; prescribing expensive only (A), dismissing
(C), or advising dose skipping (D) are unethical.
11. Which approach ensures shared decision-making in
initiating statin therapy? A. Prescribe without discussing
alternatives
B. Review risks, benefits, and patient values collaboratively
C. Insist on therapy based solely on guidelines
D. Delegate decision entirely to patient
Answer: B
Rationale: Shared decision-making balances evidence with
patient values; unilateral prescribing (A/C) and full
delegation (D) neglect clinical guidance or support.
12. An elderly patient is on five chronic medications.
What screening tool helps assess risk of inappropriate
polypharmacy? A. Glasgow Coma Scale
B. Beers Criteria
C. APGAR score
D. Braden Scale
Answer: B
Rationale: Beers Criteria identifies potentially
inappropriate meds in elderly; other tools assess unrelated
parameters.
13. An APP documents rationale for prescribing
antibiotic prophylaxis. Which best demonstrates
, accountability? A. "Patient requested antibiotic"
B. "Based on evidence for surgical-site infection
prevention"
C. "To cover all possible infections"
D. "Standard practice without review"
Answer: B
Rationale: Evidence-based rationale shows accountability;
patient request (A), blanket coverage (C), and unsupported
standard (D) lack justification.
14. When is it appropriate for an APP to co-sign a
prescription under a DEA mid-level registration? A.
Always, regardless of state law
B. Only when required by state controlled-substance
regulations
C. Never; co-signatures are obsolete
D. Only for Schedule V drugs
Answer: B
Rationale: Co-signature requirements depend on state
regulations; blanket statements (A/C/D) are incorrect.
15. Which tactic can improve adherence in a patient
with complex dosing schedule? A. Simplify to once-daily
extended-release formulations
B. Increase pill burden to reinforce regimen
C. Avoid pillboxes or reminders
D. Provide verbal instructions only once
Answer: A
