Nr565 Week 8 Final Exam Dec-2025 Actual Week 8 Final
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1. A 62-year-old patient with hypertension, controlled on lisinopril, is diagnosed
with moderate, persistent COPD. The NP wants to initiate a long-acting
bronchodilator for maintenance therapy. Which choice is MOST appropriate
considering the patient's comorbidities?
A. Albuterol MDI PRN
B. Tiotropium (Spiriva) HandiHaler
C. Salmeterol (Serevent) Diskus
D. Fluticasone/salmeterol (Advair) Diskus
Rationale: For moderate persistent COPD, a long-acting bronchodilator is first-
line. Tiotropium, a long-acting antimuscarinic (LAMA), is preferred over a long-
acting beta-agonist (LABA) like salmeterol in patients with cardiovascular disease
due to a more favorable cardiac risk profile. Inhaled corticosteroids (like in Advair)
are not first-line for COPD and increase pneumonia risk.
2. A 45-year-old female presents with an uncomplicated UTI. She has no drug
allergies. The NP prescribes nitrofurantoin monohydrate/macrocrystals
(Macrobid). When educating the patient, the NP should explain the drug's
mechanism of action is to:
A. Inhibit bacterial DNA gyrase
B. Disrupt bacterial cell wall synthesis
C. Cause bacterial protein synthesis damage via multiple mechanisms
,D. Inhibit bacterial folic acid synthesis
Rationale: Nitrofurantoin is converted by bacterial enzymes to reactive
intermediates that damage ribosomal proteins and other components, inhibiting
protein synthesis, aerobic energy metabolism, and cell wall synthesis. It is
bacteriostatic at low concentrations and bactericidal at high concentrations. (A is
fluoroquinolones, B is beta-lactams, D is trimethoprim).
3. An NP is reviewing medications for a 70-year-old male with atrial fibrillation
(CHADS-VASc score=4) and a history of GI bleeding 2 years ago. Which
anticoagulant is generally considered the SAFEST choice regarding GI bleeding
risk in this patient?
A. Warfarin
B. Dabigatran (Pradaxa)
C. Apixaban (Eliquis)
D. Rivaroxaban (Xarelto)
Rationale: In major clinical trials and real-world data, apixaban has consistently
shown a lower rate of major GI bleeding compared to warfarin, dabigatran, and
rivaroxaban. Its twice-daily dosing and lower degree of renal clearance may
contribute to this profile, making it a preferred choice in patients with high GI
bleeding risk.
4. A patient with Type 2 DM is started on empagliflozin (Jardiance). The NP's
education MUST include warning the patient about which potentially life-
threatening adverse effect?
A. Hypoglycemia
B. Necrotizing fasciitis of the perineum (Fournier's gangrene)
C. Pancreatitis
D. Lactic acidosis
*Rationale: While SGLT2 inhibitors carry risks of DKA (often euglycemic), UTI, and
genital mycotic infections, the FDA has issued a Black Box
Warning for necrotizing fasciitis of the perineum (Fournier's gangrene), a rare
but serious and life-threatening infection requiring urgent surgical intervention.
Patients must seek immediate care for any perineal pain, redness, swelling, or
fever.*
,5. A 6-year-old child with asthma, well-controlled on low-dose inhaled
fluticasone, presents with an acute eczema flare. The NP would appropriately
prescribe:
A. Oral prednisone burst
B. High-potency topical clobetasol
C. Low-mid potency topical triamcinolone 0.1% ointment
D. Topical pimecrolimus (Elidel)
Rationale: For an acute flare of atopic dermatitis, a mid-potency topical
corticosteroid like triamcinolone is first-line. High-potency steroids (clobetasol) are
avoided on thin-skin areas and in children. Oral steroids are rarely indicated.
Topical calcineurin inhibitors (pimecrolimus) are second-line for maintenance, not
acute flares.
6. According to the CDC's Clinical Practice Guideline for Prescribing Opioids for
Chronic Pain, what is the recommended morphine milligram equivalent (MME)
threshold that should trigger increased caution and more frequent monitoring?
A. 20 MME/day
B. 50 MME/day
C. 90 MME/day
D. 120 MME/day
*Rationale: The CDC Guideline recommends starting at the lowest effective dose
and cautions that increasing risk correlates with increasing dosage. ≥50
MME/day increases overdose risk relative to <20 MME/day. Doses ≥90
MME/day should be avoided or carefully justified, as risk increases substantially.*
7. An NP prescribes sumatriptan (Imitrex) for a patient with episodic migraine
with aura. Which statement is CRITICAL to include in the patient education?
A. "Take this medication daily to prevent migraines."
B. "Use this at the FIRST sign of a headache, but NEVER during the aura phase
before the headache starts."
C. "This medication is safe to combine with your DHE nasal spray."
D. "You may take up to 4 doses in a 24-hour period."
Rationale: Triptans are contraindicated during the aura phase due to a theoretical
risk of vasoconstriction affecting the ischemic cortex. They are to be taken at
the onset of the headache pain. (A is incorrect as triptans are abortive, not
, preventive. C is dangerous—DHE and triptans should not be combined within 24
hours due to additive vasoconstriction).
8. Which medication requires enrollment in a Risk Evaluation and Mitigation
Strategy (REMS) program due to the risk of agranulocytosis?
A. Methotrexate
B. Clozapine (Clozaril)
C. Carbamazepine (Tegretol)
D. Allopurinol
Rationale: Clozapine has an absolute risk of agranulocytosis, requiring
the Clozapine REMS Program. Patients must have documented ANC monitoring
before initiation, weekly for 6 months, then biweekly. Carbamazepine also carries
a risk of blood dyscrasias and requires monitoring (CBC) but does not have a
formal REMS program like clozapine.
9. An NP is managing a patient with treatment-resistant depression. After two
adequate SSRI trials failed, the NP is considering augmentation with an atypical
antipsychotic. Which agent has the most robust FDA-approved evidence for this
use?
A. Quetiapine (Seroquel)
B. Aripiprazole (Abilify)
C. Olanzapine (Zyprexa)
D. Ziprasidone (Geodon)
Rationale: Both aripiprazole and brexpiprazole are FDA-approved as adjunctive
therapy to antidepressants for major depressive disorder. Quetiapine XR is also
approved, but its metabolic side effect profile is often less favorable. Aripiprazole
has a large body of evidence supporting its efficacy in augmentation.
10. When initiating isotretinoin (Accutane) for severe nodular acne, which is the
MOST important mandatory requirement prior to the first prescription?
A. Baseline cholesterol panel
B. Two negative pregnancy tests and enrollment in the iPLEDGE program
C. Documentation of failed trials of two oral antibiotics
D. Baseline depression screening
Rationale: Isotretinoin is a Category X teratogen. The iPLEDGE program is a
stringent FDA-mandated REMS. For females of childbearing potential, two
Exam Complete 1-100 Exam Questions Proctored Via
Examplify Chamberlain University With Correct Answers
| 100% Pass Guaranteed | Graded A+ |
1. A 62-year-old patient with hypertension, controlled on lisinopril, is diagnosed
with moderate, persistent COPD. The NP wants to initiate a long-acting
bronchodilator for maintenance therapy. Which choice is MOST appropriate
considering the patient's comorbidities?
A. Albuterol MDI PRN
B. Tiotropium (Spiriva) HandiHaler
C. Salmeterol (Serevent) Diskus
D. Fluticasone/salmeterol (Advair) Diskus
Rationale: For moderate persistent COPD, a long-acting bronchodilator is first-
line. Tiotropium, a long-acting antimuscarinic (LAMA), is preferred over a long-
acting beta-agonist (LABA) like salmeterol in patients with cardiovascular disease
due to a more favorable cardiac risk profile. Inhaled corticosteroids (like in Advair)
are not first-line for COPD and increase pneumonia risk.
2. A 45-year-old female presents with an uncomplicated UTI. She has no drug
allergies. The NP prescribes nitrofurantoin monohydrate/macrocrystals
(Macrobid). When educating the patient, the NP should explain the drug's
mechanism of action is to:
A. Inhibit bacterial DNA gyrase
B. Disrupt bacterial cell wall synthesis
C. Cause bacterial protein synthesis damage via multiple mechanisms
,D. Inhibit bacterial folic acid synthesis
Rationale: Nitrofurantoin is converted by bacterial enzymes to reactive
intermediates that damage ribosomal proteins and other components, inhibiting
protein synthesis, aerobic energy metabolism, and cell wall synthesis. It is
bacteriostatic at low concentrations and bactericidal at high concentrations. (A is
fluoroquinolones, B is beta-lactams, D is trimethoprim).
3. An NP is reviewing medications for a 70-year-old male with atrial fibrillation
(CHADS-VASc score=4) and a history of GI bleeding 2 years ago. Which
anticoagulant is generally considered the SAFEST choice regarding GI bleeding
risk in this patient?
A. Warfarin
B. Dabigatran (Pradaxa)
C. Apixaban (Eliquis)
D. Rivaroxaban (Xarelto)
Rationale: In major clinical trials and real-world data, apixaban has consistently
shown a lower rate of major GI bleeding compared to warfarin, dabigatran, and
rivaroxaban. Its twice-daily dosing and lower degree of renal clearance may
contribute to this profile, making it a preferred choice in patients with high GI
bleeding risk.
4. A patient with Type 2 DM is started on empagliflozin (Jardiance). The NP's
education MUST include warning the patient about which potentially life-
threatening adverse effect?
A. Hypoglycemia
B. Necrotizing fasciitis of the perineum (Fournier's gangrene)
C. Pancreatitis
D. Lactic acidosis
*Rationale: While SGLT2 inhibitors carry risks of DKA (often euglycemic), UTI, and
genital mycotic infections, the FDA has issued a Black Box
Warning for necrotizing fasciitis of the perineum (Fournier's gangrene), a rare
but serious and life-threatening infection requiring urgent surgical intervention.
Patients must seek immediate care for any perineal pain, redness, swelling, or
fever.*
,5. A 6-year-old child with asthma, well-controlled on low-dose inhaled
fluticasone, presents with an acute eczema flare. The NP would appropriately
prescribe:
A. Oral prednisone burst
B. High-potency topical clobetasol
C. Low-mid potency topical triamcinolone 0.1% ointment
D. Topical pimecrolimus (Elidel)
Rationale: For an acute flare of atopic dermatitis, a mid-potency topical
corticosteroid like triamcinolone is first-line. High-potency steroids (clobetasol) are
avoided on thin-skin areas and in children. Oral steroids are rarely indicated.
Topical calcineurin inhibitors (pimecrolimus) are second-line for maintenance, not
acute flares.
6. According to the CDC's Clinical Practice Guideline for Prescribing Opioids for
Chronic Pain, what is the recommended morphine milligram equivalent (MME)
threshold that should trigger increased caution and more frequent monitoring?
A. 20 MME/day
B. 50 MME/day
C. 90 MME/day
D. 120 MME/day
*Rationale: The CDC Guideline recommends starting at the lowest effective dose
and cautions that increasing risk correlates with increasing dosage. ≥50
MME/day increases overdose risk relative to <20 MME/day. Doses ≥90
MME/day should be avoided or carefully justified, as risk increases substantially.*
7. An NP prescribes sumatriptan (Imitrex) for a patient with episodic migraine
with aura. Which statement is CRITICAL to include in the patient education?
A. "Take this medication daily to prevent migraines."
B. "Use this at the FIRST sign of a headache, but NEVER during the aura phase
before the headache starts."
C. "This medication is safe to combine with your DHE nasal spray."
D. "You may take up to 4 doses in a 24-hour period."
Rationale: Triptans are contraindicated during the aura phase due to a theoretical
risk of vasoconstriction affecting the ischemic cortex. They are to be taken at
the onset of the headache pain. (A is incorrect as triptans are abortive, not
, preventive. C is dangerous—DHE and triptans should not be combined within 24
hours due to additive vasoconstriction).
8. Which medication requires enrollment in a Risk Evaluation and Mitigation
Strategy (REMS) program due to the risk of agranulocytosis?
A. Methotrexate
B. Clozapine (Clozaril)
C. Carbamazepine (Tegretol)
D. Allopurinol
Rationale: Clozapine has an absolute risk of agranulocytosis, requiring
the Clozapine REMS Program. Patients must have documented ANC monitoring
before initiation, weekly for 6 months, then biweekly. Carbamazepine also carries
a risk of blood dyscrasias and requires monitoring (CBC) but does not have a
formal REMS program like clozapine.
9. An NP is managing a patient with treatment-resistant depression. After two
adequate SSRI trials failed, the NP is considering augmentation with an atypical
antipsychotic. Which agent has the most robust FDA-approved evidence for this
use?
A. Quetiapine (Seroquel)
B. Aripiprazole (Abilify)
C. Olanzapine (Zyprexa)
D. Ziprasidone (Geodon)
Rationale: Both aripiprazole and brexpiprazole are FDA-approved as adjunctive
therapy to antidepressants for major depressive disorder. Quetiapine XR is also
approved, but its metabolic side effect profile is often less favorable. Aripiprazole
has a large body of evidence supporting its efficacy in augmentation.
10. When initiating isotretinoin (Accutane) for severe nodular acne, which is the
MOST important mandatory requirement prior to the first prescription?
A. Baseline cholesterol panel
B. Two negative pregnancy tests and enrollment in the iPLEDGE program
C. Documentation of failed trials of two oral antibiotics
D. Baseline depression screening
Rationale: Isotretinoin is a Category X teratogen. The iPLEDGE program is a
stringent FDA-mandated REMS. For females of childbearing potential, two
