NR 565 FINAL EXAM 2025 | 2 DIFFERENT VERSIONS |
ADVANCED PHARMACOLOGY | ALL QUESTIONS AND
CORRECT ANSWERS (PROFESSOR VERIFIED) | ALREADY
GRADED A+ | LATEST VERSIONS (JUST RELEASED)
Advanced Pharmacology for Nurse Practitioners | Key Domains: Pharmacokinetics &
Pharmacodynamics, Prescriptive Authority & Legal/Ethical Principles, Drug Classes by System
(Cardiovascular, Respiratory, Endocrine, Psychotropic, CNS, Infectious Disease, Pain Management,
Gastrointestinal), Patient Safety, Adverse Effects & Interactions, Individualized Drug Therapy &
Monitoring, and Evidence-Based Prescribing | Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NR 565 (Advanced Pharmacology) Final Exam for 2025 provides two distinct
versions of high-quality exam-style questions with correct answers and rationales. It emphasizes
evidence-based drug selection, mechanism of action, patient-specific factors (age, comorbidities),
monitoring parameters, adverse effect management, and safe prescribing practices critical for
advanced practice nursing.
Exam Structure:
• Version A: (60 QUESTIONS)
• Version B: (60 QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining pharmacological principles, therapeutic decision-making, patient safety considerations,
and why alternative options are pharmacologically incorrect or less appropriate for the clinical
scenario.
VERSION A
,1. A 68-year-old male with hypertension, type 2 diabetes, and chronic kidney disease (CKD Stage 3)
requires antihypertensive therapy. Which agent is most appropriate as first-line therapy?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
Rationale: ACE inhibitors like lisinopril are first-line in patients with diabetes and CKD due to their
renoprotective effects, reducing proteinuria and slowing CKD progression. Thiazide diuretics lose
efficacy when GFR <30 mL/min, and beta-blockers are not preferred unless compelling indications
like post-MI exist.
2. Which pharmacokinetic parameter is most significantly altered in a patient with severe hepatic
cirrhosis?
A. Absorption
B. Metabolism
C. Distribution
D. Excretion
Rationale: The liver is the primary site of drug metabolism. In hepatic cirrhosis, reduced functional
hepatocytes and portal-systemic shunting decrease first-pass metabolism, increasing bioavailability
and half-life of high-extraction drugs (e.g., morphine, verapamil).
,3. A patient on warfarin (INR 2.8) is prescribed amiodarone for atrial fibrillation. What is the most
likely effect on the INR?
A. No change
B. INR will increase
C. INR will decrease
D. INR becomes unreliable
Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, the primary enzymes that metabolize S- and
R-warfarin, respectively. This leads to increased warfarin levels and a higher INR, requiring close
monitoring and likely dose reduction.
4. A 45-year-old female with major depressive disorder is started on fluoxetine. She returns in 10
days reporting increased anxiety, restlessness, and insomnia. The NP should:
A. Discontinue fluoxetine immediately due to serotonin syndrome
B. Reassure the patient that these are common early side effects and may subside within
1–2 weeks
C. Switch to phenelzine
D. Add alprazolam 1 mg TID indefinitely
Rationale: SSRIs commonly cause initial activation symptoms (anxiety, insomnia, GI upset) that
typically resolve within 1–2 weeks. Serotonin syndrome would include hyperreflexia, clonus,
hyperthermia, and autonomic instability—absent here. Benzodiazepines should be used short-term
if needed, not indefinitely.
, 5. Which antibiotic requires therapeutic drug monitoring (TDM) due to its narrow therapeutic index
and risk of nephrotoxicity and ototoxicity?
A. Ciprofloxacin
B. Gentamicin
C. Amoxicillin
D. Doxycycline
Rationale: Aminoglycosides (e.g., gentamicin, tobramycin) have a narrow therapeutic index. Trough
levels (drawn just before the next dose) must be monitored to avoid accumulation and toxicity
(nephrotoxicity, ototoxicity), while peak levels ensure efficacy.
6. A patient with type 2 diabetes and heart failure with reduced ejection fraction (HFrEF) has an
HbA1c of 8.9% despite metformin 2000 mg daily. Which agent should be added next?
A. Glipizide
B. Empagliflozin
C. Sitagliptin
D. Pioglitazone
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) are recommended in patients with T2DM
and HFrEF due to robust evidence of reducing heart failure hospitalizations and cardiovascular
mortality. Pioglitazone is contraindicated in heart failure; sulfonylureas increase hypoglycemia risk
without CV benefit.
ADVANCED PHARMACOLOGY | ALL QUESTIONS AND
CORRECT ANSWERS (PROFESSOR VERIFIED) | ALREADY
GRADED A+ | LATEST VERSIONS (JUST RELEASED)
Advanced Pharmacology for Nurse Practitioners | Key Domains: Pharmacokinetics &
Pharmacodynamics, Prescriptive Authority & Legal/Ethical Principles, Drug Classes by System
(Cardiovascular, Respiratory, Endocrine, Psychotropic, CNS, Infectious Disease, Pain Management,
Gastrointestinal), Patient Safety, Adverse Effects & Interactions, Individualized Drug Therapy &
Monitoring, and Evidence-Based Prescribing | Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NR 565 (Advanced Pharmacology) Final Exam for 2025 provides two distinct
versions of high-quality exam-style questions with correct answers and rationales. It emphasizes
evidence-based drug selection, mechanism of action, patient-specific factors (age, comorbidities),
monitoring parameters, adverse effect management, and safe prescribing practices critical for
advanced practice nursing.
Exam Structure:
• Version A: (60 QUESTIONS)
• Version B: (60 QUESTIONS)
Answer Format
All correct answers must appear in bold and cyan blue, accompanied by concise rationales
explaining pharmacological principles, therapeutic decision-making, patient safety considerations,
and why alternative options are pharmacologically incorrect or less appropriate for the clinical
scenario.
VERSION A
,1. A 68-year-old male with hypertension, type 2 diabetes, and chronic kidney disease (CKD Stage 3)
requires antihypertensive therapy. Which agent is most appropriate as first-line therapy?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
Rationale: ACE inhibitors like lisinopril are first-line in patients with diabetes and CKD due to their
renoprotective effects, reducing proteinuria and slowing CKD progression. Thiazide diuretics lose
efficacy when GFR <30 mL/min, and beta-blockers are not preferred unless compelling indications
like post-MI exist.
2. Which pharmacokinetic parameter is most significantly altered in a patient with severe hepatic
cirrhosis?
A. Absorption
B. Metabolism
C. Distribution
D. Excretion
Rationale: The liver is the primary site of drug metabolism. In hepatic cirrhosis, reduced functional
hepatocytes and portal-systemic shunting decrease first-pass metabolism, increasing bioavailability
and half-life of high-extraction drugs (e.g., morphine, verapamil).
,3. A patient on warfarin (INR 2.8) is prescribed amiodarone for atrial fibrillation. What is the most
likely effect on the INR?
A. No change
B. INR will increase
C. INR will decrease
D. INR becomes unreliable
Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, the primary enzymes that metabolize S- and
R-warfarin, respectively. This leads to increased warfarin levels and a higher INR, requiring close
monitoring and likely dose reduction.
4. A 45-year-old female with major depressive disorder is started on fluoxetine. She returns in 10
days reporting increased anxiety, restlessness, and insomnia. The NP should:
A. Discontinue fluoxetine immediately due to serotonin syndrome
B. Reassure the patient that these are common early side effects and may subside within
1–2 weeks
C. Switch to phenelzine
D. Add alprazolam 1 mg TID indefinitely
Rationale: SSRIs commonly cause initial activation symptoms (anxiety, insomnia, GI upset) that
typically resolve within 1–2 weeks. Serotonin syndrome would include hyperreflexia, clonus,
hyperthermia, and autonomic instability—absent here. Benzodiazepines should be used short-term
if needed, not indefinitely.
, 5. Which antibiotic requires therapeutic drug monitoring (TDM) due to its narrow therapeutic index
and risk of nephrotoxicity and ototoxicity?
A. Ciprofloxacin
B. Gentamicin
C. Amoxicillin
D. Doxycycline
Rationale: Aminoglycosides (e.g., gentamicin, tobramycin) have a narrow therapeutic index. Trough
levels (drawn just before the next dose) must be monitored to avoid accumulation and toxicity
(nephrotoxicity, ototoxicity), while peak levels ensure efficacy.
6. A patient with type 2 diabetes and heart failure with reduced ejection fraction (HFrEF) has an
HbA1c of 8.9% despite metformin 2000 mg daily. Which agent should be added next?
A. Glipizide
B. Empagliflozin
C. Sitagliptin
D. Pioglitazone
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) are recommended in patients with T2DM
and HFrEF due to robust evidence of reducing heart failure hospitalizations and cardiovascular
mortality. Pioglitazone is contraindicated in heart failure; sulfonylureas increase hypoglycemia risk
without CV benefit.
