NRNP 6560 FINAL EXAM LATEST VERSION 2 EXAM /NRNP
6560 FINAL EXAM PREPARATION WITH 100 QUESTIONS
AND CORRECT ANSWERS (VERIFIED ANSWERS) WALDEN
UNIVERSITY
Question 1
A 68-year-old male with a history of hypertension and benign prostatic
hyperplasia (BPH) is prescribed tamsulosin. The NP should educate the client
about which common adverse effect?
A) Tachycardia
B) Hypertension
C) Orthostatic hypotension
D) Urinary retention
E) Constipation
Correct Answer: C) Orthostatic hypotension
Rationale: Tamsulosin is an alpha-1 adrenergic antagonist primarily
used for BPH. Its mechanism of action can lead to vasodilation,
especially upon standing, causing orthostatic hypotension. It is
important to advise the patient to change positions slowly.
Question 2
Which of the following classes of antibiotics is associated with an increased
risk of tendon rupture, particularly in older adults and those taking
corticosteroids?
A) Penicillins
B) Cephalosporins
C) Macrolides
D) Fluoroquinolones
E) Tetracyclines
Correct Answer: D) Fluoroquinolones
Rationale: Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) carry a
black box warning for an increased risk of tendinitis and tendon
rupture, especially in clients over 60, those on corticosteroids, and
organ transplant recipients.
Question 3
A 55-year-old female client is prescribed omeprazole for gastroesophageal
reflux disease (GERD). Long-term use of proton pump inhibitors (PPIs) like
omeprazole is associated with an increased risk of:
A) Hypoglycemia
B) Hyperkalemia
C) Osteoporosis and Clostridium difficile infection
D) Nephrotoxicity
,E) Liver enzyme elevation
Correct Answer: C) Osteoporosis and Clostridium difficile infection
Rationale: Long-term PPI use has been linked to an increased risk of
osteoporosis (due to impaired calcium absorption) and Clostridium
difficile-associated diarrhea (due to alterations in gut microbiota).
Question 4
When prescribing a new medication, the NP considers the client's renal
function. This is primarily an application of which pharmacokinetic principle?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
E) Bioavailability
Correct Answer: D) Excretion
Rationale: Renal function (kidney function) is the primary
determinant of drug excretion for many medications. Impaired renal
function can lead to drug accumulation and toxicity, requiring dose
adjustments. This falls under the pharmacokinetic principle of
excretion.
Question 5
A client with hypertension is prescribed lisinopril. The NP should educate the
client about which common and potentially serious adverse effect of ACE
inhibitors?
A) Hyperkalemia
B) Bradycardia
C) Orthostatic hypertension
D) Hyperglycemia
E) Constipation
Correct Answer: A) Hyperkalemia
Rationale: ACE inhibitors (e.g., lisinopril) can cause hyperkalemia
(elevated potassium levels) by inhibiting aldosterone release. This
is especially important for clients also taking potassium-sparing
diuretics or potassium supplements.
Question 6
A 40-year-old female client with a history of migraines is prescribed
sumatriptan. The NP should advise the client that this medication is
contraindicated in which condition?
A) History of depression
,B) Hypertension
C) Coronary artery disease (CAD)
D) Asthma
E) Diabetes mellitus
Correct Answer: C) Coronary artery disease (CAD)
Rationale: Sumatriptan is a serotonin receptor agonist (triptan) that
causes vasoconstriction. It is contraindicated in clients with
coronary artery disease, uncontrolled hypertension, or other
cardiovascular conditions due to the risk of coronary vasospasm and
myocardial ischemia.
Question 7
Which of the following best describes the "first-pass effect" in pharmacology?
A) The initial side effects a client experiences when starting a new drug.
B) The metabolism of a drug by the liver before it reaches systemic
circulation, often reducing its bioavailability.
C) The time it takes for a drug to reach its maximum concentration.
D) The binding of a drug to plasma proteins.
E) The rapid excretion of a drug from the body.
Correct Answer: B) The metabolism of a drug by the liver before it
reaches systemic circulation, often reducing its bioavailability.
Rationale: The first-pass effect (or first-pass metabolism) is when a
drug is extensively metabolized by the liver on its first pass through
the portal circulation, significantly reducing the amount of
unchanged drug that reaches systemic circulation. This is
particularly relevant for orally administered drugs.
Question 8
A client with a new diagnosis of generalized anxiety disorder (GAD) is
prescribed sertraline. The NP should educate the client that therapeutic
effects may take approximately:
A) 1-3 days
B) 1-2 weeks
C) 2-4 weeks
D) 4-6 weeks
E) 6-8 weeks
Correct Answer: C) 2-4 weeks
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like
sertraline typically take 2 to 4 weeks to achieve full therapeutic
antidepressant or anxiolytic effects. Clients should be counseled
about this delay to manage expectations and encourage adherence.
, Question 9
What is the primary mechanism of action of ACE inhibitors in treating
hypertension?
A) Increasing heart rate.
B) Causing vasodilation by inhibiting the conversion of angiotensin I to
angiotensin II.
C) Directly blocking calcium channels.
D) Increasing sodium and water reabsorption.
E) Stimulating beta-adrenergic receptors.
Correct Answer: B) Causing vasodilation by inhibiting the conversion
of angiotensin I to angiotensin II.
Rationale: ACE inhibitors block the angiotensin-converting enzyme,
which prevents the formation of angiotensin II (a potent
vasoconstrictor) and also reduces aldosterone secretion, leading to
vasodilation and decreased blood pressure.
Question 10
A client is taking warfarin for atrial fibrillation. Which laboratory test is
essential to monitor the therapeutic effect of warfarin?
A) Partial Thromboplastin Time (PTT)
B) Platelet count
C) International Normalized Ratio (INR)
D) D-dimer
E) Bleeding time
Correct Answer: C) International Normalized Ratio (INR)
Rationale: The INR is the standard laboratory test used to monitor
the anticoagulant effect of warfarin. The therapeutic range for INR
typically falls between 2.0 and 3.0 for most indications.
Question 11
A 72-year-old female client with osteoporosis is prescribed alendronate. The
NP should provide which crucial administration instruction?
A) Take with food to prevent GI upset.
B) Take at bedtime to maximize absorption.
C) Take with a full glass of plain water at least 30-60 minutes before
food/other medications, and remain upright for at least 30-60 minutes.
D) Chew the tablet for better absorption.
E) Take with milk to enhance calcium absorption.
Correct Answer: C) Take with a full glass of plain water at least 30-60
minutes before food/other medications, and remain upright for at
least 30-60 minutes.
6560 FINAL EXAM PREPARATION WITH 100 QUESTIONS
AND CORRECT ANSWERS (VERIFIED ANSWERS) WALDEN
UNIVERSITY
Question 1
A 68-year-old male with a history of hypertension and benign prostatic
hyperplasia (BPH) is prescribed tamsulosin. The NP should educate the client
about which common adverse effect?
A) Tachycardia
B) Hypertension
C) Orthostatic hypotension
D) Urinary retention
E) Constipation
Correct Answer: C) Orthostatic hypotension
Rationale: Tamsulosin is an alpha-1 adrenergic antagonist primarily
used for BPH. Its mechanism of action can lead to vasodilation,
especially upon standing, causing orthostatic hypotension. It is
important to advise the patient to change positions slowly.
Question 2
Which of the following classes of antibiotics is associated with an increased
risk of tendon rupture, particularly in older adults and those taking
corticosteroids?
A) Penicillins
B) Cephalosporins
C) Macrolides
D) Fluoroquinolones
E) Tetracyclines
Correct Answer: D) Fluoroquinolones
Rationale: Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) carry a
black box warning for an increased risk of tendinitis and tendon
rupture, especially in clients over 60, those on corticosteroids, and
organ transplant recipients.
Question 3
A 55-year-old female client is prescribed omeprazole for gastroesophageal
reflux disease (GERD). Long-term use of proton pump inhibitors (PPIs) like
omeprazole is associated with an increased risk of:
A) Hypoglycemia
B) Hyperkalemia
C) Osteoporosis and Clostridium difficile infection
D) Nephrotoxicity
,E) Liver enzyme elevation
Correct Answer: C) Osteoporosis and Clostridium difficile infection
Rationale: Long-term PPI use has been linked to an increased risk of
osteoporosis (due to impaired calcium absorption) and Clostridium
difficile-associated diarrhea (due to alterations in gut microbiota).
Question 4
When prescribing a new medication, the NP considers the client's renal
function. This is primarily an application of which pharmacokinetic principle?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
E) Bioavailability
Correct Answer: D) Excretion
Rationale: Renal function (kidney function) is the primary
determinant of drug excretion for many medications. Impaired renal
function can lead to drug accumulation and toxicity, requiring dose
adjustments. This falls under the pharmacokinetic principle of
excretion.
Question 5
A client with hypertension is prescribed lisinopril. The NP should educate the
client about which common and potentially serious adverse effect of ACE
inhibitors?
A) Hyperkalemia
B) Bradycardia
C) Orthostatic hypertension
D) Hyperglycemia
E) Constipation
Correct Answer: A) Hyperkalemia
Rationale: ACE inhibitors (e.g., lisinopril) can cause hyperkalemia
(elevated potassium levels) by inhibiting aldosterone release. This
is especially important for clients also taking potassium-sparing
diuretics or potassium supplements.
Question 6
A 40-year-old female client with a history of migraines is prescribed
sumatriptan. The NP should advise the client that this medication is
contraindicated in which condition?
A) History of depression
,B) Hypertension
C) Coronary artery disease (CAD)
D) Asthma
E) Diabetes mellitus
Correct Answer: C) Coronary artery disease (CAD)
Rationale: Sumatriptan is a serotonin receptor agonist (triptan) that
causes vasoconstriction. It is contraindicated in clients with
coronary artery disease, uncontrolled hypertension, or other
cardiovascular conditions due to the risk of coronary vasospasm and
myocardial ischemia.
Question 7
Which of the following best describes the "first-pass effect" in pharmacology?
A) The initial side effects a client experiences when starting a new drug.
B) The metabolism of a drug by the liver before it reaches systemic
circulation, often reducing its bioavailability.
C) The time it takes for a drug to reach its maximum concentration.
D) The binding of a drug to plasma proteins.
E) The rapid excretion of a drug from the body.
Correct Answer: B) The metabolism of a drug by the liver before it
reaches systemic circulation, often reducing its bioavailability.
Rationale: The first-pass effect (or first-pass metabolism) is when a
drug is extensively metabolized by the liver on its first pass through
the portal circulation, significantly reducing the amount of
unchanged drug that reaches systemic circulation. This is
particularly relevant for orally administered drugs.
Question 8
A client with a new diagnosis of generalized anxiety disorder (GAD) is
prescribed sertraline. The NP should educate the client that therapeutic
effects may take approximately:
A) 1-3 days
B) 1-2 weeks
C) 2-4 weeks
D) 4-6 weeks
E) 6-8 weeks
Correct Answer: C) 2-4 weeks
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like
sertraline typically take 2 to 4 weeks to achieve full therapeutic
antidepressant or anxiolytic effects. Clients should be counseled
about this delay to manage expectations and encourage adherence.
, Question 9
What is the primary mechanism of action of ACE inhibitors in treating
hypertension?
A) Increasing heart rate.
B) Causing vasodilation by inhibiting the conversion of angiotensin I to
angiotensin II.
C) Directly blocking calcium channels.
D) Increasing sodium and water reabsorption.
E) Stimulating beta-adrenergic receptors.
Correct Answer: B) Causing vasodilation by inhibiting the conversion
of angiotensin I to angiotensin II.
Rationale: ACE inhibitors block the angiotensin-converting enzyme,
which prevents the formation of angiotensin II (a potent
vasoconstrictor) and also reduces aldosterone secretion, leading to
vasodilation and decreased blood pressure.
Question 10
A client is taking warfarin for atrial fibrillation. Which laboratory test is
essential to monitor the therapeutic effect of warfarin?
A) Partial Thromboplastin Time (PTT)
B) Platelet count
C) International Normalized Ratio (INR)
D) D-dimer
E) Bleeding time
Correct Answer: C) International Normalized Ratio (INR)
Rationale: The INR is the standard laboratory test used to monitor
the anticoagulant effect of warfarin. The therapeutic range for INR
typically falls between 2.0 and 3.0 for most indications.
Question 11
A 72-year-old female client with osteoporosis is prescribed alendronate. The
NP should provide which crucial administration instruction?
A) Take with food to prevent GI upset.
B) Take at bedtime to maximize absorption.
C) Take with a full glass of plain water at least 30-60 minutes before
food/other medications, and remain upright for at least 30-60 minutes.
D) Chew the tablet for better absorption.
E) Take with milk to enhance calcium absorption.
Correct Answer: C) Take with a full glass of plain water at least 30-60
minutes before food/other medications, and remain upright for at
least 30-60 minutes.
