NR568 Advanced Pharmacology for the
AGPCNP – Weeks 1-4 Midterm Exam
(2026-2027) – Complete Review & Study Guide
| APRN Focused
60 Questions | Outpatient-Focused | Guidelines & Geriatrics Threaded Throughout
(Single-Best-Answer = 47 | Multiple-Select = 8 | Prescription-Review = 5)
SECTION 1: PRESCRIPTIVE PRINCIPLES & GEROPHARMACOLOGY
Q1. 78-year-old woman, eGFR 45 mL/min, BP 142/88 on lisinopril 20 mg. Uses ibuprofen
400 mg 2-3×/week for knee pain. Highest priority?
A) ↑ lisinopril to 40 mg
B) Switch atorvastatin to rosuvastatin
C) Deprescribe ibuprofen
D) Add amlodipine 5 mg
Correct: C
Rationale: NSAID + ACEi + CKD = AKI & hyperK⁺ risk; Beers “avoid” NSAIDs in stage 3b+
CKD.
Q2. SATA. Which factors decrease renal clearance of drugs in older adults? (Select all.)
,A) ↓ GFR
B) ↓ muscle mass → ↓ creatinine production
C) ↓ hepatic CYP activity
D) ↑ P-glycoprotein in proximal tubule
E) ↓ albumin
Correct: A, B
Rationale: C & E alter PK but not renal clearance; P-gp (D) ↑ would enhance secretion.
Q3. During a brown-bag review, a patient brings OTC “sleep aid” containing
diphenhydramine 50 mg. Which counseling is priority?
A) Take ½ tab to reduce cost
B) Avoid driving next morning
C) Monitor for urinary retention
D) Discontinue due to anticholinergic burden
Correct: D
Rationale: Beers Criteria: diphenhydramine → confusion, falls, constipation; safer
alternatives (melatonin, CBT-I).
Q4. Which cytochrome polymorphism most affects clopidogrel activation?
A) CYP2D6 *4
, B) CYP2C19 *2
C) CYP3A5 *3
D) CYP1A2 *1F
Correct: B
Rationale: 2C19 loss-of-function → ↓ formation of active metabolite → ↑
stent-thrombosis risk.
Q5. Prescription Review. A 68-year-old man with CKD 4 is prescribed colchicine 0.6 mg
BID for gout flare. Identify the issue.
A) Dose appropriate for flare
B) Under-dosed; should be 1.2 mg now then 0.6 mg in 1 h
C) Reduce to 0.6 mg daily (renal adjustment)
D) Switch to indomethacin instead
Correct: C
Rationale: Colchicine neuropathy/myopathy risk when eGFR < 30; 50% dose reduction &
longer interval.
SECTION 2: CARDIOVASCULAR PHARMACOTHERAPY
Q6. Black male, 55 yr, BP 152/96, no DM/CKD. First-line agent per JNC-8?
A) Lisinopril
B) Chlorthalidone 12.5 mg
AGPCNP – Weeks 1-4 Midterm Exam
(2026-2027) – Complete Review & Study Guide
| APRN Focused
60 Questions | Outpatient-Focused | Guidelines & Geriatrics Threaded Throughout
(Single-Best-Answer = 47 | Multiple-Select = 8 | Prescription-Review = 5)
SECTION 1: PRESCRIPTIVE PRINCIPLES & GEROPHARMACOLOGY
Q1. 78-year-old woman, eGFR 45 mL/min, BP 142/88 on lisinopril 20 mg. Uses ibuprofen
400 mg 2-3×/week for knee pain. Highest priority?
A) ↑ lisinopril to 40 mg
B) Switch atorvastatin to rosuvastatin
C) Deprescribe ibuprofen
D) Add amlodipine 5 mg
Correct: C
Rationale: NSAID + ACEi + CKD = AKI & hyperK⁺ risk; Beers “avoid” NSAIDs in stage 3b+
CKD.
Q2. SATA. Which factors decrease renal clearance of drugs in older adults? (Select all.)
,A) ↓ GFR
B) ↓ muscle mass → ↓ creatinine production
C) ↓ hepatic CYP activity
D) ↑ P-glycoprotein in proximal tubule
E) ↓ albumin
Correct: A, B
Rationale: C & E alter PK but not renal clearance; P-gp (D) ↑ would enhance secretion.
Q3. During a brown-bag review, a patient brings OTC “sleep aid” containing
diphenhydramine 50 mg. Which counseling is priority?
A) Take ½ tab to reduce cost
B) Avoid driving next morning
C) Monitor for urinary retention
D) Discontinue due to anticholinergic burden
Correct: D
Rationale: Beers Criteria: diphenhydramine → confusion, falls, constipation; safer
alternatives (melatonin, CBT-I).
Q4. Which cytochrome polymorphism most affects clopidogrel activation?
A) CYP2D6 *4
, B) CYP2C19 *2
C) CYP3A5 *3
D) CYP1A2 *1F
Correct: B
Rationale: 2C19 loss-of-function → ↓ formation of active metabolite → ↑
stent-thrombosis risk.
Q5. Prescription Review. A 68-year-old man with CKD 4 is prescribed colchicine 0.6 mg
BID for gout flare. Identify the issue.
A) Dose appropriate for flare
B) Under-dosed; should be 1.2 mg now then 0.6 mg in 1 h
C) Reduce to 0.6 mg daily (renal adjustment)
D) Switch to indomethacin instead
Correct: C
Rationale: Colchicine neuropathy/myopathy risk when eGFR < 30; 50% dose reduction &
longer interval.
SECTION 2: CARDIOVASCULAR PHARMACOTHERAPY
Q6. Black male, 55 yr, BP 152/96, no DM/CKD. First-line agent per JNC-8?
A) Lisinopril
B) Chlorthalidone 12.5 mg
