NP Medication Management Practice Exam
with 150 questions, Answers And
Rationales.
2025/2026
1. Which antihypertensive class is considered first-line for a patient
with chronic kidney disease?
A. Beta-blockers
B. Calcium channel blockers
C. ACE inhibitors
D. Thiazide diuretics
Rationale: ACE inhibitors reduce proteinuria and slow progression of
kidney disease, making them first-line for CKD patients.
2. A patient with type 2 diabetes is not achieving glycemic control on
metformin. What is an appropriate next step?
A. Increase metformin dose only
B. Add a GLP-1 receptor agonist
C. Discontinue metformin
D. Start insulin immediately
Rationale: GLP-1 receptor agonists provide additional glycemic control
and cardiovascular benefits in type 2 diabetes when metformin alone
is insufficient.
3. Which of the following antibiotics is contraindicated in pregnancy?
A. Amoxicillin
,B. Tetracycline
C. Cephalexin
D. Azithromycin
Rationale: Tetracyclines can cause fetal teeth discoloration and inhibit
bone growth, making them contraindicated in pregnancy.
4. Which medication is preferred for acute exacerbation of heart
failure with volume overload?
A. ACE inhibitor
B. Loop diuretic
C. Beta-blocker
D. Digoxin
Rationale: Loop diuretics rapidly reduce fluid overload in acute heart
failure exacerbations.
5. A patient on warfarin presents with INR of 6.0 but no bleeding.
Which is the best initial management?
A. Increase warfarin dose
B. Hold warfarin and monitor INR
C. Administer vitamin K immediately
D. Switch to DOAC
Rationale: For INR >4.5 without bleeding, holding warfarin and
monitoring is usually sufficient; vitamin K is reserved for higher INR or
bleeding.
6. Which drug is first-line for generalized anxiety disorder?
A. Benzodiazepines
,B. SSRIs
C. Tricyclic antidepressants
D. Beta-blockers
Rationale: SSRIs are first-line for long-term management of
generalized anxiety disorder due to efficacy and safety profile.
7. What is the maximum daily dose of acetaminophen for a healthy
adult?
A. 2 g
B. 4 g
C. 6 g
D. 1 g
Rationale: The maximum recommended daily dose for a healthy adult
is 4 g to avoid hepatotoxicity.
8. Which medication requires regular monitoring of serum levels due
to narrow therapeutic index?
A. Lisinopril
B. Metformin
C. Lithium
D. Simvastatin
Rationale: Lithium has a narrow therapeutic range, and toxicity can
occur easily, requiring frequent serum level monitoring.
9. A patient with atrial fibrillation and high stroke risk is started on
anticoagulation. Which is preferred if there is no mechanical heart
valve?
, A. Warfarin only
B. Aspirin
C. DOAC (e.g., apixaban, rivaroxaban)
D. Clopidogrel
Rationale: DOACs are preferred for non-valvular atrial fibrillation due
to fewer monitoring requirements and similar efficacy to warfarin.
10. Which antihypertensive is preferred in a pregnant patient?
A. ACE inhibitor
B. ARB
C. Labetalol
D. Thiazide diuretics
Rationale: Labetalol is considered safe in pregnancy, whereas ACE
inhibitors and ARBs are contraindicated.
11. What is the first-line pharmacologic treatment for osteoarthritis
pain?
A. Corticosteroids
B. Acetaminophen
C. NSAIDs
D. Opioids
Rationale: Acetaminophen is considered first-line due to safety and
efficacy for mild-to-moderate osteoarthritis pain.
12. Which lipid-lowering agent is most effective at reducing LDL
cholesterol?
A. Fibrates
with 150 questions, Answers And
Rationales.
2025/2026
1. Which antihypertensive class is considered first-line for a patient
with chronic kidney disease?
A. Beta-blockers
B. Calcium channel blockers
C. ACE inhibitors
D. Thiazide diuretics
Rationale: ACE inhibitors reduce proteinuria and slow progression of
kidney disease, making them first-line for CKD patients.
2. A patient with type 2 diabetes is not achieving glycemic control on
metformin. What is an appropriate next step?
A. Increase metformin dose only
B. Add a GLP-1 receptor agonist
C. Discontinue metformin
D. Start insulin immediately
Rationale: GLP-1 receptor agonists provide additional glycemic control
and cardiovascular benefits in type 2 diabetes when metformin alone
is insufficient.
3. Which of the following antibiotics is contraindicated in pregnancy?
A. Amoxicillin
,B. Tetracycline
C. Cephalexin
D. Azithromycin
Rationale: Tetracyclines can cause fetal teeth discoloration and inhibit
bone growth, making them contraindicated in pregnancy.
4. Which medication is preferred for acute exacerbation of heart
failure with volume overload?
A. ACE inhibitor
B. Loop diuretic
C. Beta-blocker
D. Digoxin
Rationale: Loop diuretics rapidly reduce fluid overload in acute heart
failure exacerbations.
5. A patient on warfarin presents with INR of 6.0 but no bleeding.
Which is the best initial management?
A. Increase warfarin dose
B. Hold warfarin and monitor INR
C. Administer vitamin K immediately
D. Switch to DOAC
Rationale: For INR >4.5 without bleeding, holding warfarin and
monitoring is usually sufficient; vitamin K is reserved for higher INR or
bleeding.
6. Which drug is first-line for generalized anxiety disorder?
A. Benzodiazepines
,B. SSRIs
C. Tricyclic antidepressants
D. Beta-blockers
Rationale: SSRIs are first-line for long-term management of
generalized anxiety disorder due to efficacy and safety profile.
7. What is the maximum daily dose of acetaminophen for a healthy
adult?
A. 2 g
B. 4 g
C. 6 g
D. 1 g
Rationale: The maximum recommended daily dose for a healthy adult
is 4 g to avoid hepatotoxicity.
8. Which medication requires regular monitoring of serum levels due
to narrow therapeutic index?
A. Lisinopril
B. Metformin
C. Lithium
D. Simvastatin
Rationale: Lithium has a narrow therapeutic range, and toxicity can
occur easily, requiring frequent serum level monitoring.
9. A patient with atrial fibrillation and high stroke risk is started on
anticoagulation. Which is preferred if there is no mechanical heart
valve?
, A. Warfarin only
B. Aspirin
C. DOAC (e.g., apixaban, rivaroxaban)
D. Clopidogrel
Rationale: DOACs are preferred for non-valvular atrial fibrillation due
to fewer monitoring requirements and similar efficacy to warfarin.
10. Which antihypertensive is preferred in a pregnant patient?
A. ACE inhibitor
B. ARB
C. Labetalol
D. Thiazide diuretics
Rationale: Labetalol is considered safe in pregnancy, whereas ACE
inhibitors and ARBs are contraindicated.
11. What is the first-line pharmacologic treatment for osteoarthritis
pain?
A. Corticosteroids
B. Acetaminophen
C. NSAIDs
D. Opioids
Rationale: Acetaminophen is considered first-line due to safety and
efficacy for mild-to-moderate osteoarthritis pain.
12. Which lipid-lowering agent is most effective at reducing LDL
cholesterol?
A. Fibrates
